Limits...
Abnormal Head Impulse Test in a Unilateral Cerebellar Lesion.

Baek SH, Choi JY, Jung JM, Kwon do Y, Park MH, Choi J, Kim JS - J Clin Neurol (2014)

Bottom Line: However, results of bithermal caloric tests and rotatory chair test were normal.MRI revealed a lesion in the inferior cerebellum near the flocculus.This case provides additional evidence that damage to the flocculus or its connections may impair the vestibulo-ocular reflex only during high-speed stimuli, especially when the stimuli are applied to the contralesional side.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

ABSTRACT

Background: The findings of head impulse tests (HIT) are usually normal in cerebellar lesions.

Case report: A 46-year-old male presented with progressive dizziness and imbalance of 3 weeks duration. The patient exhibited catch-up saccades during bedside horizontal HIT to either side, which was more evident during the rightward HIT. However, results of bithermal caloric tests and rotatory chair test were normal. MRI revealed a lesion in the inferior cerebellum near the flocculus.

Conclusions: This case provides additional evidence that damage to the flocculus or its connections may impair the vestibulo-ocular reflex only during high-speed stimuli, especially when the stimuli are applied to the contralesional side. By observing accompanying cerebellar signs, the abnormal HIT findings caused by a cerebellar disorder can be distinguished from those produced by peripheral vestibular disorders.

No MeSH data available.


Related in: MedlinePlus

T2-weighted (A and C) and gadolinium-enhanced T1-weighted (B and D) MRIs show a round cystic lesion located in the left inferior cerebellum. The lesion is bordered by the flocculus anterolaterally, paraflocculus (tonsil) medially, and inferior and middle cerebellar peduncles anteromedially.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4507384&req=5

Figure 1: T2-weighted (A and C) and gadolinium-enhanced T1-weighted (B and D) MRIs show a round cystic lesion located in the left inferior cerebellum. The lesion is bordered by the flocculus anterolaterally, paraflocculus (tonsil) medially, and inferior and middle cerebellar peduncles anteromedially.

Mentions: Serology revealed positive human immunodeficiency virus antigen and antibody, which was subsequently confirmed by Western blotting. The serum venereal disease research laboratory titer was low (1:2), and the fluorescent treponemal antibody absorption test was negative. Evaluations of autoimmune (antinuclear, antineutrophil cytoplasmic, and anti-Ro, -La, and -Jo-1 antibodies) and paraneoplastic conditions were unremarkable. CD4+ T cells were decreased to 137/mm3 (8.1%; normal range=27-60%). The CSF profile was normal, with negative viral (antibodies for herpes simplex types 1 and 2, varicella zoster, Epstein-Barr, cytomegalovirus, enterovirus, and John Cunningham virus), bacterial, fungal (cryptococcus and aspergillosis), tuberculosis, and parasitic markers. MRI revealed a round lesion located in the biventor lobule adjacent to the flocculus, tonsil, and inferior cerebellar peduncle (Fig. 1). Although antiretroviral agents were initiated with a presumptive diagnosis of progressive multifocal leukoencephalopathy associated with acquired immunodeficiency syndrome, the patient's symptoms were not relieved.


Abnormal Head Impulse Test in a Unilateral Cerebellar Lesion.

Baek SH, Choi JY, Jung JM, Kwon do Y, Park MH, Choi J, Kim JS - J Clin Neurol (2014)

T2-weighted (A and C) and gadolinium-enhanced T1-weighted (B and D) MRIs show a round cystic lesion located in the left inferior cerebellum. The lesion is bordered by the flocculus anterolaterally, paraflocculus (tonsil) medially, and inferior and middle cerebellar peduncles anteromedially.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4507384&req=5

Figure 1: T2-weighted (A and C) and gadolinium-enhanced T1-weighted (B and D) MRIs show a round cystic lesion located in the left inferior cerebellum. The lesion is bordered by the flocculus anterolaterally, paraflocculus (tonsil) medially, and inferior and middle cerebellar peduncles anteromedially.
Mentions: Serology revealed positive human immunodeficiency virus antigen and antibody, which was subsequently confirmed by Western blotting. The serum venereal disease research laboratory titer was low (1:2), and the fluorescent treponemal antibody absorption test was negative. Evaluations of autoimmune (antinuclear, antineutrophil cytoplasmic, and anti-Ro, -La, and -Jo-1 antibodies) and paraneoplastic conditions were unremarkable. CD4+ T cells were decreased to 137/mm3 (8.1%; normal range=27-60%). The CSF profile was normal, with negative viral (antibodies for herpes simplex types 1 and 2, varicella zoster, Epstein-Barr, cytomegalovirus, enterovirus, and John Cunningham virus), bacterial, fungal (cryptococcus and aspergillosis), tuberculosis, and parasitic markers. MRI revealed a round lesion located in the biventor lobule adjacent to the flocculus, tonsil, and inferior cerebellar peduncle (Fig. 1). Although antiretroviral agents were initiated with a presumptive diagnosis of progressive multifocal leukoencephalopathy associated with acquired immunodeficiency syndrome, the patient's symptoms were not relieved.

Bottom Line: However, results of bithermal caloric tests and rotatory chair test were normal.MRI revealed a lesion in the inferior cerebellum near the flocculus.This case provides additional evidence that damage to the flocculus or its connections may impair the vestibulo-ocular reflex only during high-speed stimuli, especially when the stimuli are applied to the contralesional side.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

ABSTRACT

Background: The findings of head impulse tests (HIT) are usually normal in cerebellar lesions.

Case report: A 46-year-old male presented with progressive dizziness and imbalance of 3 weeks duration. The patient exhibited catch-up saccades during bedside horizontal HIT to either side, which was more evident during the rightward HIT. However, results of bithermal caloric tests and rotatory chair test were normal. MRI revealed a lesion in the inferior cerebellum near the flocculus.

Conclusions: This case provides additional evidence that damage to the flocculus or its connections may impair the vestibulo-ocular reflex only during high-speed stimuli, especially when the stimuli are applied to the contralesional side. By observing accompanying cerebellar signs, the abnormal HIT findings caused by a cerebellar disorder can be distinguished from those produced by peripheral vestibular disorders.

No MeSH data available.


Related in: MedlinePlus